Pictorial medication labeling to improve health literacy among women: A randomized controlled trial in a maternal health clinic in rural Kutch, India

Objective: To investigate the efficacy of a pictorial medication labeling intervention in improving comprehension and recall of medical information among illiterate women in a remote region of western India.

Methods: The intervention consisted of pictorial labels, depicting both dosage and indication of each medication prescribed. A randomized controlled trial was conducted with 136 pregnant women visiting a private maternal and child health clinic from November 2007 thru June 2008, comparing women receiving labels to those not receiving labels at their visit. Follow-up surveys were conducted 2-7 days following the clinic visit. All collected data were self-reported by study participants.

Results: Women in control and intervention groups did not vary significantly by education, religion, age, parity, gestation of current pregnancy, or household size (p<0.05). Initial results showed no significant difference between control and intervention groups in comprehension of dosage (not adjusted for regimen complexity and number of medicines prescribed)(p>.05). Eighty-eight percent of women surveyed believed it was important to know the indication of each medicine they were prescribed, and women receiving labels were 2 times more likely than women in the control group to know their medications' indications. Over 75 percent of women given labels found the pictorial system easier to understand than the traditional tick-mark system.

Conclusions: The pictorial labels increased recall of medical indication among participants. Further research is needed to investigate the long-term benefits of a pictorial system for communicating medication information, as well as to examine the effect of a pictorial system on adherence and health outcomes.